Objective To study the pathogenesis, clinical symptoms, surgical treatment and preventive measures of esophagogastric-arterial fistula following resection for carcinoma of the esophagus and cardia. Methods The clinical data of 18 patients with esophagogastric-arterial fistula were retrospective analyzed. Results There were 14 patients of esophageal carcinoma and 4 patients of cardiac carcinoma.7 patients had supra-aortic esophagogastric anastomosis(2 near the apex of pleura) and 11 had anastomosis under the aortic arch. Fatal hemorrhage occurred postoperatively from 11 to 93 days. The interval between hemorrhage and death varied from being instant to 18 days.All patients died. Conclusion The surgical treatment provide an opportunity for those patients. Successful management is possible if early diagnosis is made and prompt surgical management is undertaken. Preventive measures of peptic ulcer and esophageal fistula can decrease occurrence of this complication.

Objective To study the effect of positive lymph node number on the survival of patients with esophageal carcinoma. Methods From July 1995 to July 2005, a total of 11,447 resected lymph nodes were obtained from 1140 patients who underwent curative resection of the primary tumor with systematic lymphadenectomy at Shanxi cancer hospital. The survivals were analysed by life tables and Kaplan-Meier methods, the related factors of lymph node metastasis were assessed by Chi-square test. Results The number of positive lymph nodes was negatively related to survival rates of esophageal carcinoma. According to the number of lymph nodes resected (≥8 nodes versus <8 nodes), there was significant difference in metastatic lymph node ratio. Conclusion The number of positive lymph node can reflect the prognosis of patients better. The authors suggest that the modification of the tumor-lymphnode-metastasis (TNM) staging classification (TNM) to include the number of positive lymph nodes in the N1 category.

Objective To investigate the effect of tumor length and number of positive lymph nodes and the ratio of positive lymph nodes on survival in patients with esophageal squamous cell carcinoma.Methods From July 1995 to July 2005, a total of 6,691 resected lymph nodes were obtained from 526patients who underwent curative resection of the primary tumour with systematic lymphadenectomy. The survivals were analysed by life tables and Kaplan-Meier methods. Results Among patients with regional disease, the number of positive lymph nodes (＞3) was related to an increasing risk. The proportion of positive lymph nodes compared with the number of lymph nodes dissected (20 %) conferred an increased risk. The tumor length (≤5 cm, 5 cm ＜ length ＜ 7 cm, ＞7 cm) was related to an increasing risk (84.74 %, 47.79 %,36.90 %, 35.52 %; 73.41%, 46.29 %, 23.87 %, 20.64 %; 64.44 %, 13.92 %, 0, 0). Conclusion Tumor length,the number of positive lymph nodes, and the ratio of positive lymph nodes are important prognostic factors for survival in patients with esophageal carcinoma. The PTNM classification system for patients with esophageal carcinoma might consider adding number of positive lymph nodes as an important prognostic factor.

BACKGROUNDBronchoplasty plus pulmonary arterioplasty has become one of the standard surgical operation for central-type lung cancer. The aim of this study is to review the surgical experience of bronchoplasty and pulmonary arterioplasty in treatment of central-type lung cancer.

METHODSFrom 1987 to 2005, 56 patients with central-type lung cancer underwent bronchoplasty and pulmonary arterioplasty. There were 45 males and 11 females with a mean age of 56 years. According to pTNM classification, 18 cases were in stage IIB, and 32 in stage IIIA and 6 in stage IIIB. Histologically, there were 35 cases of squamous cell carcinoma, 14 cases of adenocarcinoma, 4 cases of small cell lung cancer and 3 cases of carcinoid. The surgical procedures included sleeve resection of bronchus for 30 cases, wedge resection of bronchus for 26 cases, and sleeve resection of pulmonary artery for 16 cases and wedge resection of pulmonary artery for 40 cases.

RESULTSOne patient died in the perioperative period. The overall 1-, 3-, and 5-year survival rate was 79.6% (43/54), 48.1% (25/52) and 34.0% (17/50), respectively.

CONCLUSIONSThe results suggest that bronchoplasty and pulmonary arterioplasty can decrease the proportions of total pneumonectomy and exploratory thoracotomy and expand the indication of operation. Bronchoplasty and pulmonary arterioplasty can be achieved with satisfactory outcome for central-type lung cancer, especially for those patients with advanced lesions or poor pulmonary function.